Medsurg Respiratory Exam Questions With Complete Answers

MEDSURG RESPIRATORY EXAM QUESTIONS WITH COMPLETE ANSWERS Nursing diagnoses of pulmonary TB -Answer-Ineffective airway clearance Ineffective breathing pattern Anxiety Impaired gas exchange Imbalanced nutrition—because the drugs are harsh (nausea, vomiting, diarrhea) Activity intolerance Noncompliance**** Because they are so harsh, the patient often wants to stop taking them Non-compliance -Answer-What is the biggest issue with management of pulmonary TB? Nursing management of pulmonary TB -Answer-Major role is teaching about meds & compliance Patent airway (encourage to keep well hydrated because of systemic effects of antibiotic) Encourage activity Nutritional plan to prevent malnourishment Infection control-proper PPE Community follow-up DOT—directly observed therapy Directly-observed therapy is healthcare workers observe patients as they take their medicine. -Answer-What is DOT? Medications** Adequate fluids Monitor temp Smoking & balanced diet Prevent infection Recognition of recurrence symptoms Follow-up care for at least 1 year during active treatment -Answer-Client teaching with pulmonary TB should include: Pulmonary embolism -Answer-An occlusion of a portion of the pulmonary artery or one of its branches by a thrombus. Most develop from thrombi (blood clot), but could be from tumour, air, fat, bone marrow, hole in amniotic sac, etc. Associated with trauma, surgery, pregnancy, heart failure, age older than 50, hyper coagulable states, and prolonged immobility True, can be lethal depending on size—could die within an hour -Answer-True or false, pulmonary embolism is a medical emergency Causes of pulmonary embolism -Answer-DVT Fracture of large bones Other sources: Heart failure Age 50 Obesity (fat emboli) Amniotic fluid Air & other foreign substances Tumors 1. Stasis of blood (or turbulence) 2. Vessel wall injury 3. Hypercoagulability -Answer-Triad of virchow includes: Stasis of blood (or turbulence) -Answer-alteration in blood flow, generally occurs when blood flow is reduced; gives it reason to pool and clot Vessel wall injury -Answer-endothelial lining of vessel is damaged/injury Hypercoagulability -Answer-increased clotting potential of patient's blood Immobility -Answer-_____ increases the risk for all of these factors *You should always look at your patients risk factors especially in regard to the triad of Virchow. Risk factors of PE -Answer-Prolonged immobility (venous stasis) Hypercoagulability Endothelial damage Age Family history Recent surgery Medical conditions Lifestyle Manifestations of PE -Answer-Dependent upon size and location of thrombus: Dyspnea (most common symptom) ** Tachypnea (most common sign) ** Pleuritic chest pain **—this is very sudden Anxiety (sense of doom)/apprehension ** Diaphoresis Cough; hemoptysis Low grade fever Tachycardia, crackles, S3 &S4 ↓O2 sats/ increase respirations Syncope Dyspnea, tachypnea, pleuritic chest pain, and anxiety (sense of doom), apprehension -Answer-The four most important manifestations to note if patient is experiencing these symptoms of PE are: Dyspnea -Answer-The most common symptom of PE is: Tachypnea -Answer-The most common sign of PE is: Pleuritic chest pain -Answer-A very sudden manifestation of PE is: Diagnostic tests of PE -Answer-CXR, CT D-Dimer, ABGs, PT/PTT/INR, ventilation perfusion (VQ) scan, and pulmonary angiography CT -Answer-Shows 3D slices of the chest D-Dimer -Answer-blood test, is a product of fibrin lyses (breakdown). Measures the breakdown of the products of the actual blood clot. Not definitive. ABGs of PE -Answer-typically they are in respiratory alkalosis; PO2 and PACO2 levels are low Respiratory alkalosis (PO2 and PACO2 levels are low) (pH is high) -Answer-PE patients are typically in: PT/PTT/INR -Answer-these are to assume a baseline level for anticoagulation treatment. If patient has a PE they will get a loading dose of heparin right away, and then on an warfarin infusion. Ventilation perfusion (VQ) scan -Answer-lung scan where radioactive agent is injected into patient and studies the airflow into the lungs. Also helps visualize pulmonary vasculature (blood flow) Pulmonary angiography -Answer-inject dye into vena cava and look to see if there is a blockage in the pulmonary blockage, and locate exactly where it is. This is the best method, but is very invasive and risky. Management of PE -Answer-Stabilizing the cardiopulmonary system Patient may be intubated, IV fluids, bronchodilators, steroids, etc. Anticoagulant therapy Fibrinolytic therapy Pulmonary embolectomy Vena cava filter Pharmacological therapy of PE -Answer-Anticoagulants, thrombolytics (clot dissolver) are: Anticoagulants -Answer-They would have blood work done to see PT (prothrombin time), PTT (partial thrombotic time) and INR (international normalized ratio) Heparin Warfarin Heparin -Answer-decrease clotting of blood and decrease chances of another clot forming Antidote is protein Warfarin -Answer-Once INR is at a level of 2 or 3, warfarin can be introduced. Once they maintain 2-3 for 3-5 days, it can then be stopped This has a long half-life, so if patient has a procedure, the drug has to be stopped 5-7 days or else there is a high chance of bleeding WARFARIN ANTIDOTE IS VITAMIN K—patient shouldn't eat food high in vitamin K because it can reduce Nursing diagnoses of pulmonary TB -Answer-Ineffective airway clearance Ineffective breathing pattern Anxiety Impaired gas exchange Imbalanced nutrition—because the drugs are harsh (nausea, vomiting, diarrhea) Activity intolerance Noncompliance**** Because they are so harsh, the patient often wants to stop taking them Non-compliance -Answer-What is the biggest issue with management of pulmonary TB? Nursing management of pulmonary TB -Answer-Major role is teaching about meds & compliance Patent airway (encourage to keep well hydrated because of systemic effects of antibiotic) Encourage activity Nutritional plan to prevent malnourishment Infection control-proper PPE Community follow-up DOT—directly observed therapy Directly-observed therapy is healthcare workers observe patients as they take their medicine. -Answer-What is DOT? Medications** Adequate fluids Monitor temp Smoking & balanced diet Prevent infection Recognition of recurrence symptoms Follow-up care for at least 1 year during active treatment -Answer-Client teaching with pulmonary TB should include: Pulmonary embolism -Answer-An occlusion of a portion of the pulmonary artery or one of its branches by a thrombus. Most develop from thrombi (blood clot), but could be from tumour, air, fat, bone marrow, hole in amniotic sac, etc. Associated with trauma, surgery, pregnancy, heart failure, age older than 50, hyper coagulable states, and prolonged immobility True, can be lethal depending on size—could die within an hour -Answer-True or false, pulmonary embolism is a medical emergency Causes of pulmonary embolism -Answer-DVT Fracture of large bones Other sources: Heart failure Age 50 Obesity (fat emboli) Amniotic fluid Air & other foreign substances Tumors 1. Stasis of blood (or turbulence) 2. Vessel wall injury 3. Hypercoagulability -Answer-Triad of virchow includes: Stasis of blood (or turbulence) -Answer-alteration in blood flow, generally occurs when blood flow is reduced; gives it reason to pool and clot Vessel wall injury -Answer-endothelial lining of vessel is damaged/injury Hypercoagulability -Answer-increased clotting potential of patient's blood Immobility -Answer-_____ increases the risk for all of these factors *You should always look at your patients risk factors especially in regard to the triad of Virchow. Risk factors of PE -Answer-Prolonged immobility (venous stasis) Hypercoagulability Endothelial damage Age Family history Recent surgery Medical conditions Lifestyle Manifestations of PE -Answer-Dependent upon size and location of thrombus: Dyspnea (most common symptom) ** Tachypnea (most common sign) ** Pleuritic chest pain **—this is very sudden Anxiety (sense of doom)/apprehension ** Diaphoresis Cough; hemoptysis Low grade fever Tachycardia, crackles, S3 &S4 ↓O2 sats/ increase respirations Syncope Dyspnea, tachypnea, pleuritic chest pain, and anxiety (sense of doom), apprehension -Answer-The four most important manifestations to note if patient is experiencing these symptoms of PE are: Dyspnea -Answer-The most common symptom of PE is: Tachypnea -Answer-The most common sign of PE is: Pleuritic chest pain -Answer-A very sudden manifestation of PE is: Diagnostic tests of PE -Answer-CXR, CT D-Dimer, ABGs, PT/PTT/INR, ventilation perfusion (VQ) scan, and pulmonary angiography CT -Answer-Shows 3D slices of the chest D-Dimer -Answer-blood test, is a product of fibrin lyses (breakdown). Measures the breakdown of the products of the actual blood clot. Not definitive. ABGs of PE -Answer-typically they are in respiratory alkalosis; PO2 and PACO2 levels are low Respiratory alkalosis (PO2 and PACO2 levels are low) (pH is high) -Answer-PE patients are typically in: PT/PTT/INR -Answer-these are to assume a baseline level for anticoagulation treatment. If patient has a PE they will get a loading dose of heparin right away, and then on an warfarin infusion. Ventilation perfusion (VQ) scan -Answer-lung scan where radioactive agent is injected into patient and studies the airflow into the lungs. Also helps visualize pulmonary vasculature (blood flow) Pulmonary angiography -Answer-inject dye into vena cava and look to see if there is a blockage in the pulmonary blockage, and locate exactly where it is. This is the best method, but is very invasive and risky. Management of PE -Answer-Stabilizing the cardiopulmonary system Patient may be intubated, IV fluids, bronchodilators, steroids, etc. Anticoagulant therapy Fibrinolytic therapy Pulmonary embolectomy Vena cava filter Pharmacological therapy of PE -Answer-Anticoagulants, thrombolytics (clot dissolver) are: Anticoagulants -Answer-They would have blood work done to see PT (prothrombin time), PTT (partial thrombotic time) and INR (international normalized ratio) Heparin Warfarin Heparin -Answer-decrease clotting of blood and decrease chances of another clot forming Antidote is protein Warfarin -Answer-Once INR is at a level of 2 or 3, warfarin can be introduced. Once they maintain 2-3 for 3-5 days, it can then be stopped This has a long half-life, so if patient has a procedure, the drug has to be stopped 5-7 days or else there is a high chance of bleeding WARFARIN ANTIDOTE IS VITAMIN K—patient shouldn't eat food high in vitamin K because it can reduce Nursing diagnoses of pulmonary TB -Answer-Ineffective airway clearance Ineffective breathing pattern Anxiety Impaired gas exchange Imbalanced nutrition—because the drugs are harsh (nausea, vomiting, diarrhea) Activity intolerance Noncompliance**** Because they are so harsh, the patient often wants to stop taking them Non-compliance -Answer-What is the biggest issue with management of pulmonary TB? Nursing management of pulmonary TB -Answer-Major role is teaching about meds & compliance Patent airway (encourage to keep well hydrated because of systemic effects of antibiotic) Encourage activity Nutritional plan to prevent malnourishment Infection control-proper PPE Community follow-up DOT—directly observed therapy Directly-observed therapy is healthcare workers observe patients as they take their medicine. -Answer-What is DOT? Medications** Adequate fluids Monitor temp Smoking & balanced diet Prevent infection Recognition of recurrence symptoms Follow-up care for at least 1 year during active treatment -Answer-Client teaching with pulmonary TB should include: Pulmonary embolism -Answer-An occlusion of a portion of the pulmonary artery or one of its branches by a thrombus. Most develop from thrombi (blood clot), but could be from tumour, air, fat, bone marrow, hole in amniotic sac, etc. Associated with trauma, surgery, pregnancy, heart failure, age older than 50, hyper coagulable states, and prolonged immobility True, can be lethal depending on size—could die within an hour -Answer-True or false, pulmonary embolism is a medical emergency Causes of pulmonary embolism -Answer-DVT Fracture of large bones Other sources: Heart failure Age 50 Obesity (fat emboli) Amniotic fluid Air & other foreign substances Tumors 1. Stasis of blood (or turbulence) 2. Vessel wall injury 3. Hypercoagulability -Answer-Triad of virchow includes: Stasis of blood (or turbulence) -Answer-alteration in blood flow, generally occurs when blood flow is reduced; gives it reason to pool and clot Vessel wall injury -Answer-endothelial lining of vessel is damaged/injury Hypercoagulability -Answer-increased clotting potential of patient's blood Immobility -Answer-_____ increases the risk for all of these factors *You should always look at your patients risk factors especially in regard to the triad of Virchow. Risk factors of PE -Answer-Prolonged immobility (venous stasis) Hypercoagulability Endothelial damage Age Family history Recent surgery Medical conditions Lifestyle Manifestations of PE -Answer-Dependent upon size and location of thrombus: Dyspnea (most common symptom) ** Tachypnea (most common sign) ** Pleuritic chest pain **—this is very sudden Anxiety (sense of doom)/apprehension ** Diaphoresis Cough; hemoptysis Low grade fever Tachycardia, crackles, S3 &S4 ↓O2 sats/ increase respirations Syncope Dyspnea, tachypnea, pleuritic chest pain, and anxiety (sense of doom), apprehension -Answer-The four most important manifestations to note if patient is experiencing these symptoms of PE are: Dyspnea -Answer-The most common symptom of PE is: Tachypnea -Answer-The most common sign of PE is: Pleuritic chest pain -Answer-A very sudden manifestation of PE is: Diagnostic tests of PE -Answer-CXR, CT D-Dimer, ABGs, PT/PTT/INR, ventilation perfusion (VQ) scan, and pulmonary angiography CT -Answer-Shows 3D slices of the chest D-Dimer -Answer-blood test, is a product of fibrin lyses (breakdown). Measures the breakdown of the products of the actual blood clot. Not definitive. ABGs of PE -Answer-typically they are in respiratory alkalosis; PO2 and PACO2 levels are low Respiratory alkalosis (PO2 and PACO2 levels are low) (pH is high) -Answer-PE patients are typically in: PT/PTT/INR -Answer-these are to assume a baseline level for anticoagulation treatment. If patient has a PE they will get a loading dose of heparin right away, and then on an warfarin infusion. Ventilation perfusion (VQ) scan -Answer-lung scan where radioactive agent is injected into patient and studies the airflow into the lungs. Also helps visualize pulmonary vasculature (blood flow) Pulmonary angiography -Answer-inject dye into vena cava and look to see if there is a blockage in the pulmonary blockage, and locate exactly where it is. This is the best method, but is very invasive and risky. Management of PE -Answer-Stabilizing the cardiopulmonary system Patient may be intubated, IV fluids, bronchodilators, steroids, etc. Anticoagulant therapy Fibrinolytic therapy Pulmonary embolectomy Vena cava filter Pharmacological therapy of PE -Answer-Anticoagulants, thrombolytics (clot dissolver) are: Anticoagulants -Answer-They would have blood work done to see PT (prothrombin time), PTT (partial thrombotic time) and INR (international normalized ratio) Heparin Warfarin Heparin -Answer-decrease clotting of blood and decrease chances of another clot forming Antidote is protein